Surgery has been performed since ancient times. The earliest recorded surgical operations were circumcision and trepanation.

(Circumcision removal of the foreskin of the penis.

Trepanation making a hole in the skull to relieve pressure and/or release spirits.)

The earliest instruments used in these procedures were flint or obsidian (shiny stone) knives and saws.

3

Nursing did not exist as an occupation in the United States before the Civil War.

4

A typical "operating room" was in the open air where the surgeon had plenty of light.

Otherwise, it was the room of a farmhouse, the center of a barn, or under a tree.

Assistants held lamps over the surgeon to provide light.

Patients were placed on a door removed from its hinges and set on sawhorses.

With little more than a rag to wipe his hands, the surgeon then began the examination of the wounded soldier and then decided on what course to take.

5

Although the women who tended the sick and wounded during the Revolutionary War were not nurses as known in the modern sense, they helped blaze the trail for another generation nearly one hundred years later, when, in 1873, civilian hospitals in America began operating recognized schools of nursing.

6

Anesthesia was discovered by two American dentists, Horace Wells (1815-1848) and William Morton

Before the advent of anesthesia surgery was a traumatically painful procedure and surgeons were encouraged to be as swift as possible to minimize patient suffering.

Also meant that operations were largely restricted to amputations and external growth removals.

Beginning in the 1840s surgery began to change dramatically in character with the discovery of effective and practical anaesthetic chemicals such as ether and chloroform. In Britain, John Snow pioneered the use of these two anaesthetics.

In addition to relieving patient suffering, anaesthesia allowed more intricate operations in the internal regions of the human body. The further discovery of muscle relaxants also facilitated safer applications.

Period of time that constitutes the surgical experience includes the preoperative, intraoperative, and postoperative phases of nursing care.

13Preoperative phase

Period of time from when the decision for surgical intervention is made to when the patient is transferred to the operating room table.

14Intraoperative phase

Period of time from when the patient is transferred to the operating room table to when he or she is admitted to the postanesthesia care unit (PACU).

15Postoperative phase

Period of time that begins with the admission of the patient to the PACU and ends after a follow-up evaluation in the clinical setting or home.

16

Operating Room (OR) nurses

referred to as perioperative nurses to more accurately reflect their specialized duties

17

As surgical care evolves, so does the role of the registered nurse who assists with patient care in the operating room.

18Perioperative nurses

RNs

work in

hospital

surgical departments

day-surgery units (ambulatory surgery)

physicians offices

Work closely with the surgical patient, family members and other health-care professionals to help

Plan

implement

evaluate treatment

19Being a nurse in the OR

Offers you the opportunity to acquire and use professional, technical, and practical skills, and problem-solving skills.

20

As with everything else in nursing and medicine and nursing, the OR is a fluid environment .

21The effect of technology on OR nurses

The nurse has to have knowledge of the working of and be able to trouble shoot problems with any and all equipment used in the OR's

Microscope

Fluid pumps

Video equipment

Lasers

22

If there is a problem with any of the equipment the nurse hasto be able to initiate corrective action for the malfunctioning equipment.

23

The exponential growth of OR technology during the past 10 years has placed increased demands on perioperative nurses.

24Other equipment that is used in the OR

Surgical lights

OR tables, accessories and furniture

Oxygen and nitrous oxide lines

Computerized monitors and video equipment

Lasers

Robotic equipment

Nitrogen tanks

Drills saws

Cement system

Emergency cardiac equipment

Warming blanket/Bair hugger

25

Proficiency is required not only in patient care but also in the understanding, operating, and troubleshooting of video systems, computers, and cutting edge medical devices

26OR Terminology

excision - cutting out an organ, tumor, or other body part.

resection - partial removal of an organ or other bodily structure.

reconnection of organs, tissues, etc., particularly if severed. Resection of organs such as intestines involves reconnection. Internal suturing or stapling may be used. Surgical connection between blood vessels or other tubular or hollow structures such as loops of intestine is called anastomosis.

ligation - tying off blood vessels, ducts, or "tubes".

grafts - may be severed pieces of tissue cut from the same (or different) body or flaps of tissue still partly connected to the body but resewn for rearranging or restructuring of the area of the body in question. Grafts may be taken from one area of the patient's body and inserted to another area of the body or may be from other persons, cadavers, or animals.

27The Nursing Process in Perioperative practice 28Like all nurses, OR nurses use

Knowledge

Skills

Judgment

29

Implements nursingactions to ensure and maintain a safe environment for thepatient

30

Manages the overall nursing care in the operating room and helping to maintain a safe, comfortable environment.

31

Performs sharps, sponge, and instrumentcounts per policy with the scrub tech or scrub nurse

32

Implements the safe transfer of the patient to and from theOR bed and ensures that the side rails and safety straps are used appropriately.

Responsible for positioning of the patient using proper body alignment and body mechanics anddemonstrates proper positioning of the patient on the ORequipment that is appropriate to the operative procedure

33

Maintains the patient's skin integrity and ensuresthat clothing and bedding are clean and dry, uses proper techniques when prepping the surgical site and adjusts bedding and clothing by lifting rather than using shearing force

34

Checks sterility of items to be used during the operative procedure by verifying the expiration date, package integrity and by the sterile indicator color change

35

Opening instruments and sterile suppliesusing sterile technique to the back table

Pouringsterile solutions into sterile containers

Adjusting the ORlights

36

Preparing labels and taking care of specimens per policy

Remaining with the patient during induction of anesthesiaand assisting anesthesia with the induction

Assisting with gowning of surgical team members

37

Anticipating needs of thesurgical team members

Supplying items as needed

Sending forthe next patient in a timely manner

Perparing forsubsequent procedures.

38Roles in the OR 39Circulating Nurse

The circulators duties are performed outside the sterile field.

The circulator is responsible for managing the nursing care of the patient within the OR and coordinating the needs of the surgical team with other care providers necessary for completion of surgery.

Using critical thinking skills, the circulator nurse observes the surgery and the surgical team from a broad perspective and assists the team to create and maintain a safe and comfortable environment for the patient.

The circulator nurse assesses the patients condition before, during, and after the operation to ensure an optimal outcome for the patient.

Circulating during surgery is a perioperative nursing function. The role of the circulator may not be delegated to a UAP, Licensed Practice Nurse or Licensed Vocational Nurse.

40

In the operating room, most patients are anesthetized or sedated and are powerless to make decisions on their own behalf during the intraoperative phase. The circulating nurse serves as the patient advocate while the patient is least able to care for him or herself

41Scrub Nurse

The scrub nurse works directly with the surgeon within the sterile field, passing instruments, sponges, and other items needed during the procedure.

The sterile field is the area closely surrounding the OR table and instrument tray.

Surgical team members who work within the sterile field have scrubbed their hands and arms with special disinfecting soap and generally wear surgical gowns, caps, eyewear, and gloves.

This is a nursing role that may be delegated to a LPN.

42Surgeon

MD or DO

Credentialed by the hospital

Must be a graduate of an accredited medical school and complete a surgical residency.

43Anesthesia Care Provider

Anesthesiologist

MD or DO

Supervising physician for CRNAs

CRNA

RN with additional education

Current entry level for practice is Masters degree

44Sterile processing

Responsible for providing sterile instrumentation to OR for use in cases

45

Perioperative nurses also may work as an OR director, managing budgets, staffing, and other business aspects of the operating room.

46

Some perioperative nurses may later consider a career in business as a management consultant, clinical educator, researcher, or medical sales professional.

47

AORN is the professional organization of perioperative nurses representing over 40,000 nurses

48Important information for your clinical experience in the OR 49

Your experience starts where the patient enters the system.

2nd Floor Same Day Admission

OPS prep area (basement)

Change into scrubs when your patient moves to the holding area

50Holding Area

Last chart review by RN to make sure all required paperwork is on the chart.

IV started

Interview with anesthesiologist

51In the OR

Lockers are available for your use during the hours between 0700-1800 while you are in the operating room.

You must bring your own lock.

52DRESS CODE - SURGICAL ATTIRE

All persons who enter the semi restricted and restricted areas of the surgical suite should be in hospital laundered surgical attire intended for use only within the surgical suite at Presbyterian Hospital. Surgical attire includes hospital issued scrubs, scrub jacket and head cover. Shoe covers are not necessary.

All possible head and facial hair, including sideburns and neckline, should be covered when in the surgical suite.

53

All persons entering an operating room or should wear a mask.

Masks are located over the scrub sinks in each suite.

All personnel entering the suite should have all jewelry confined or removed.

Watches and plain wedding bands are acceptable.

Earrings must be covered by the scrub cap.

54

Protective barriers (gloves, masks, protective eyewear, and face shields) are provided by the hospital and should be utilized to reduce the risk of exposure to potentially infective agents.

Shoe covers are not required. If shoe covers are necessary, the wearer should remove them before leaving the operating room to avoid tracking blood and debris through the department.

Edges of anything that encloses sterile contents are considered unsterile.

Sterile field is created as close as possible to time of use.

Sterile areas are continuously kept in view.

Non-sterile persons should stay at least 12 inches from the sterile field

57

Sterile persons keep well within sterile area.

Unsterile persons avoid sterile areas.

Destruction of integrity of microbial barriers results in contamination.

Microorganisms must be kept to irreducible minimum.

58

Enjoy your

experience

in

Perioperative Services

59Remember

Act interested

Ask questions

About PowerShow.com

PowerShow.com is a leading presentation/slideshow sharing website. Whether your application is business, how-to, education, medicine, school, church, sales, marketing, online training or just for fun, PowerShow.com is a great resource. And, best of all, most of its cool features are free and easy to use.

You can use PowerShow.com to find and download example online PowerPoint ppt presentations on just about any topic you can imagine so you can learn how to improve your own slides and
presentations for free. Or use it to find and download high-quality how-to PowerPoint ppt presentations with illustrated or animated slides that will teach you how to do something new, also for free. Or use it to upload your own PowerPoint slides so you can share them with your teachers, class, students, bosses, employees, customers, potential investors or the world. Or use it to create really cool photo slideshows - with 2D and 3D transitions, animation, and your choice of music - that you can share with your Facebook friends or Google+ circles. That's all free as well!

For a small fee you can get the industry's best online privacy or publicly promote your presentations and slide shows with top rankings. But aside from that it's free. We'll even convert your presentations and slide shows into the universal Flash format with all their original multimedia glory, including animation, 2D and 3D transition effects, embedded music or other audio, or even video embedded in slides. All for free. Most of the presentations and slideshows on PowerShow.com are free to view, many are even free to download. (You can choose whether to allow people to download your original PowerPoint presentations and photo slideshows for a fee or free or not at all.) Check out PowerShow.com today - for FREE. There is truly something for everyone!

presentations for free. Or use it to find and download high-quality how-to PowerPoint ppt presentations with illustrated or animated slides that will teach you how to do something new, also for free. Or use it to upload your own PowerPoint slides so you can share them with your teachers, class, students, bosses, employees, customers, potential investors or the world. Or use it to create really cool photo slideshows - with 2D and 3D transitions, animation, and your choice of music - that you can share with your Facebook friends or Google+ circles. That's all free as well!

For a small fee you can get the industry's best online privacy or publicly promote your presentations and slide shows with top rankings. But aside from that it's free. We'll even convert your presentations and slide shows into the universal Flash format with all their original multimedia glory, including animation, 2D and 3D transition effects, embedded music or other audio, or even video embedded in slides. All for free. Most of the presentations and slideshows on PowerShow.com are free to view, many are even free to download. (You can choose whether to allow people to download your original PowerPoint presentations and photo slideshows for a fee or free or not at all.) Check out PowerShow.com today - for FREE. There is truly something for everyone!